Effect of Intracoronary Nicorandil Administration on Preventing No-Reflow/Slow Flow Phenomenon During Rotational Atherectomy

A major limitation of the rotational atherectomy (RA) procedure is the occurrence of the no-reflow/slow flow phenomenon and the optimal strategy is still evolving. Recent clinical studies have demonstrated the beneficial effects of nicorandil, an adenosine triphosphate (ATP)-sensitive potassium channel opener, on no-reflow in patients with acute myocardial infarction. The purpose of this study was to evaluate the effect of nicorandil on no-reflow/slow flow phenomenon during RA procedures. Sixty-one patients who underwent RA of complex coronary lesions were randomly divided into 2 groups: (i) nicorandil cocktail (n=24 patients, 37 lesions) and (ii) verapamil cocktail (n=37 patients, 63 lesions). In each group, the drug cocktail mixed with pressurized saline was infused through the 4Fr Teflon sheath of the rotablator system during the RA procedure. In the nicorandil group, the drug cocktail consisted of 24 mg of nicorandil, 5 mg of nitroglycerin, and 10,000 U of heparin. In the verapamil group, the drug cocktail consisted of 10 mg of verapamil, 5 mg of nitroglycerin, and 10,000 U of heparin. Baseline and procedure characteristics did not differ between the 2 groups. RA was performed successfully, and death, Q-wave myocardial infarction, or emergency coronary artery bypass surgery did not occur in any patients. The no-reflow/slow flow phenomenon was observed in 11/63 (17.4%) lesions of the verapamil group, but in only 1/37 (2.7%) lesions of the nicorandil group (p=0.03). No untoward complications were observed during nicorandil infusion. These data indicate that the intracoronary continuous infusion of nicorandil during RA procedures is easy and safe, and prevents no-reflow/slow flow phenomenon more effectively than infusion of verapamil.